3

H.—3a.

work to be done here than can be properly accomplished by these last-mentioned officers, provided as they are with only one female assistant. Of their industry and ability Ijhave no doubt, but they cannot keep the hospital and grounds in creditable order without additional assistance. 23rd January, 1883.

AUCKLAND. I hate made a thorough inspection of this hospital and the surrounding premises, and have seen and conversed with all the patients—ninety-eight in number. The building is stuccoed; three storeys in height. The four principal wards occupy the wings on the two higher floors; and at the two outer corners of each wings are towers containing the lavatories, closets, and bath-rooms. The central portion of the two upper storeys contains the two fever-wards, Matron's and nurses' rooms, above; and, below, the Board-room, operating-room, library, and accident-ward. On the ground floor are the dining-room for convalescents ; the kitchen, scullery, and pantry; various store-rooms, several small private wards, two rooms for the medical officer, and, at the extreme end, the dispensary and reception-room. In the basement are the mortuary and engine-house. The situation of the hospital is admirable, and magnificent views of the harbour and surrounding country may be had from the balconies which run along the front of the building on the two upper floors. The estate covers about eleven acres, upon part of ■which are situated the " refuges " for men and women. There is neither flower- nor vegetable-garden. Nothing whatever appears to be done is this direction : I did not see a flower either inside or outside the hospital. The buildings generally appear to me to be in good repair. The water-supply is derived from the city mains at considerable pressure. There is one internal hydrant, and sufficient indiarubber hose to reach any part of the establishment. A small engine can be used for pumping if the ordinary supply should fail. The boiler supplies steam for cooking and water-heating. It is examined annually by a Government official. The hospital, as a whole, may be said to be well planned. The large wards are about 13 feet high, and are lighted by sash-windows, the upper part of which is hinged to open inwards. There are also ventilators in the ceilings, and " hit-and-miss " ventilators near the floor-line. Open fireplaces are arranged for burning wood, and gas-pendants are used for lighting. Linoleum floorcloth is laid down along the centre of the floor. There are Venetian blinds in front, and others of blue holland behind. Iron bedsteads are in use, and these are fitted with straw paillasses and hair mattresses. The pillows are filled with flock or hair, very few feather ones being in use. Many of the bedsteads are very hollow in the middle, and the paillasses and mattresses are in very bad condition. Vermin are said to abound; and I can well believe that this is the case, as I saw evidences of much neglect. The whole of the mattresses urgently require re-making. It would perhaps be better to burn the paillasses and replace them with new ones, after repairing the bedsteads, and taking means to prevent the laths from rusting and injuring the cases. The bed-clothing I found to be of good quality, regularly changed, and very clean. This was also the case with the patients' under-linen and nightdresses. Small dwarf lockers are placed beside each bed: these are too low to form tables for use at meals. There is a folding camp-stool at the foot of each bed, and some "Windsor chairs in each ward. In the large female ward are two plain rocking-chairs; but I could find no others, nor any form of easy-chair, elsewhere. A table, at which convalescent patients take their meals, near the end of each ward, and two commodes, complete the list of furniture. There are no pictures, and only a few plain Scriptural texts on the walls. The smaller wards have a very similar outfit. The female nursing (which is confined to the large ward for females and to the female fever-ward) is performed by the Matron, an assistant nurse, and a night-nurse. The Matron takes her meals in an adjoining room, but sleeps at home; as also does the night-nurse. In this division of the hospital the patients appeared to be well and kindly treated, and so they expressed themselves to me. Everything was, moreover, orderly and very clean. I cannot, however, approve of the arrangement whereby, at present, the same nurses attend upon the ordinary patients and those suffering from fever. The same thing is done when scarlet fever is present. The means of isolating such patients in the central rooms are by no means efficient, and the mode of nursing them not satisfactory. The male fever-ward has nine beds : eight of these are occupied by typhoid-fever cases, and the other by an old-patient, who does the whole of the nursing, and sleeps in the same ward. At present ho has some assistance from a convalescent patient, and he certainly does everything in his power for the good of those under his charge. The ward he keeps beautifully clean also ; but the arrangement is a very bad one, and may end in disaster. The nursing —if I can call it by that name —in the other male wards is of the most wretched description. In No. 1 there is an old man who is paid to take charge of it. No. 3 is under the care of another old man brought from the liefuge for that purpose. In the other wards there is no assistance but what the patients can render to each other. Such a system as this would not be tolerated at Home, nor have I seen anything so bad at any other of the colonial hospitals. Convalescent patients are overtaxed with scrubbing and other onerous work. If they can perform this without injury, they ought not to remain in hospital; and if, as I believe, it is likely to retard or interfere with their recovery, they should not be expected to do it. As it is, there are evidences of neglect apparent everywhere. The rooms are not cleaned, as the rules (hanging on the walls) enjoin. Bath-rooms are littered with brooms, rags, boots, and clothing ; window-sills with medicines, papers, and dressings, for which no proper places are provided ; and, worse than all, the beds of helpless patients remain unmade for days together. A radical change is required here, and could not fail to produce good results. The lavatories, baths, and closets are of good construction, and in good working order. An apparatus* for heating water in the wardpantries is of bad construction,-and makes the whole building seem to vibrate. A small coil of steamtubing should be placed in these tanks, with an outlet for condensed water: this would obviate the disturbance. The convalescents' dining-room is not used as such, which is a matter for regret. I saw here three patients occupying " shake-downs;" of which there was also one in the Board-room. Some of the small wards on the lower floor have been occupied by patients of filthy habits, and by cases of delirium tremens. They are very offensive, and require a thorough renovation. The whole interior of the hospital requires colouring and painting. The woodwork is particularly shabby. A cool safe is